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<br /> WORK ORDE,,,SERVICE AGREEMENT
<br /> 30, Evergreen Environmental Services N° 474218
<br /> dedieaa d m the 1),werlion r Jdle On•irnnnren/
<br /> To schedule a pickup, call Send payment to: Sales Order # O`ayi
<br /> 800-596-9455 Evergreen Oil, Inc.
<br /> 6880 Smith Ave..Newark,CA EPA#CAD982413262 RO. BOX 30517 101
<br /> 16540 S-San Pedro St.,Carson.CA EPA#CA0982413262 Los Angeles.CA 90030-0517 Dale:_
<br /> GENERA'1'OR/JOn LOCATION BILLING INFORMATION
<br /> N. TIE AA,, NAME GASH❑ CHECK❑
<br /> ADDRESS .ADDRESS CUtil'ONIER CODE:NO.
<br /> Gt✓�l�t.
<br /> 1 - STATE, %IP CO. CITY STATE, 21P CO. PO p
<br /> PHONE NO. PHONE NO. PROFILE NO. CUS'I'O\1ER FPA ID NO.
<br /> � 337 t 1 l 4
<br /> PRODUCT WASTE NIANIFEST QUANTITY UNITS PRICE AMOUNT
<br /> CODE NU81nRR
<br /> Deal ail.Nun-RCRA Hazanhal, Lahriculin- CA22Gal.
<br /> Waste.Liquid Industrial CA221 Gal.
<br /> CA I 3AX Zj%?$jW_V11Z z.c> Gal.
<br /> o',w Lx w
<br /> au tt,a-GmlXnunr LxllaP s.ns.cs ('mit Gal.
<br /> I'/1,�111 tail(,nLnnnA'•I ailX naNp'mIlXll/HXIe
<br /> Oil&Watci.Non-RCRA HauudouS W'uste Liquid CA221 Gal.
<br /> Waste Solids and Sludges Gal.
<br /> wall,Om Each
<br /> Drained Used Oil fillers Drum
<br /> Nun-RCN.\ Hazardous Wash Solid,Wil)'dehri,) ('A22 i DNlll
<br /> hntpty Drwus Drum
<br /> Tnnsplmation His.
<br /> Non Wrrardlnu\ Pier Gal.
<br /> Gecol Blllk 50/50 (ial.
<br /> Gh'pd 1)alk Cons. Gal.
<br /> TFS'I' Clnr D Tech 41N1PPIn ❑Clnr D Tech IIXN) Pass❑Foil n Halo#en Detector/Flame Tea Pass ❑ Fail
<br /> Field Sera e,Work Descriplinn: Total ChargeS
<br /> Other:
<br /> Ogler
<br /> Vacuum Se 'ices Time _ _
<br /> Oni nl Y' d On Site 011 Site Oa(Load Stan UII Lund lied I(emrn h 'ant
<br /> TSI r Consolidated Manifest
<br /> Laerawn Oil.Inc. ❑ F.terereea F.u, Sao. ❑ I;,emraen Gn'.Sec. A1S Filler,
<br /> 6X8(1 Smith Arc, Rnal 30B 4139 N.Valcmine 15131 (']ark A,'e.
<br /> No%art.CA 945M Rnis.CA 95616 Frcwlo.CA 937'2 Industry.CA 71745
<br /> CAD94nXX74IF CAO982446874 (AD9X446XX2 (ArXHXX)974.3'
<br /> Lcergn n i t' S\e L,ngn t Fur Sac. LJ i]Ct R CI'R El Gr nl d'Fine.SO,
<br /> IGhl14 \ Ym I cd 4s A\\ 113 0u;;vin 944 I SI noon Att. 331111W sl m 474 Tu ,n CircleC
<br /> (anon C \ )11' Sant,t\I tri \93454 Los Ane I C\'NI01I t num
<br /> : Cu, (A )4597 \ III r Spun CA /5.5_
<br /> CAD981696 gn C\D9$ 446858 C M)MII NIL)It CALIIINR)')lio7 CA160) 14-111
<br /> ( n r❑rn
<br /> cluji-le,that it ha I ihll.h I I pr nn in 11 reduce the volume or
<br /> SOLtI'cc: COIICClit)n StatiOn ❑Government qutnoi)&I+nail)ut;h, h.va J ,.,,:an. t'1111 d,gno demnnmed by
<br /> :1C3j Marine Agricultural Industria Rctmrxler u'IK:ronumicalh pmaielble.
<br /> - 1 hereby cel1dl'y thin 1 have read and hate the aulhority try
<br /> �
<br /> h,rbind the aMrve listed aenendor to the terms nn the reverse
<br /> Retain sample #SG. 2+ �S ,A t t '�ZZ side of this roan,
<br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL.
<br /> Per Calirornia Health and Sarely Code Section 25250.9, Fta'grarn hcichy adaiscs cusntun•r(hill custonter'S shipment or used oil nary lIe
<br /> Icmapuned ht a IaUIttY that a,requited Io COMI)k talth Icnlu:d lccujalion, applicable u, mona,ement It t� but that is nui ¢•yuu'ed u+
<br /> conapla tailh the nwte.iris xon( aequucmentn applicable to hazaudou.- W a(C nl 11 cement I adios. S;nlifol I I]act le,
<br /> Ih.a h:uxll Ol process unCJ
<br /> t)il ale reglnled IO meat diose morC Suin e I nequlr nu.nh and 'O Ile uta o6.111c 'Polio" tit rl In aCS, u. d II oII ntcet thu,e r you Ilt�nil:.
<br /> Tile include marc sn inoern Ieak detection Lund III C% un rcquirc11lenu.elr'ineerm-, ceruhrniO . ni I:utA nil'Tril\. ,Ind tinancial d<AII AnCC, 1i,r .
<br /> ck st re anJ;,;L LII al rric:uev. II i, I:ocall to Sent ux•d ail la cul-,d-slate I'ncilinja> 4ntt.y)1ogtlp o with I a d sed nil m:due::nntnl ztanal:utl,
<br /> ;u 1 0( Ihc,C nkn'r su'im_anl rcyuirculcnlS. !-his nolil'iiali"11 is lar inlin'mad"It�(tlpo,es
<br /> D It
<br /> i\cr SIPIdu:r, 'tint \:!n1e pInnc 1111'. Colo, r'< Si_Il:l.lr. ! - _.11111
<br /> a 'd b602LL4602 HILI O?d314/wIl HQZuw NNIS diD :0T 80 92 dOS
<br />
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